- Hormonal treatment used in several cancers
- Usually works by reducing steroid production
Breast cancer
- Aim of hormonal treatment is to reduce oestrogenic growth
stimulation of cancer cells
- Effective in women with oestrogen and / or progesterone
receptor-positive tumours
- 50-60% of breast cancer are ER or PR positive
- 70% of receptor-positive tumours will respond to hormonal
manipulation
- Only 5% of receptor-negative tumours will respond
Types of hormonal treatment
- Ovarian ablation
- Surgical
- Radiotherapy
- LH-RH analogues
- Selective oestrogen receptor modulators
- Tamoxifen
- Raloxifene
- Fulvestrant
- Aromatase inhibitors
- Non-steroidal - anastozole, letrozole
- Steroidal - exemestane
- Progestogens
- Megestrol acetate
- Medroxyprogesterone acetate
Uses of hormonal treatment
- Can be used as adjuvant treatment or in metastatic disease
- In adjuvant setting tamoxifen or an aromatase inhibitor is given for
5 years
- Both have been shown to
- Reduce risk of recurrence
- Increase survival
- Reduce risk of contralateral breast cancer
- In patients with metastatic disease use of hormonal therapy depends
on
- ER / PR status of the tumour
- Duration of disease-free interval
- Location of metastases
- Previous therapy
- Patient's performance status
Prostate cancer
- Aim of treatment is to ablate androgen production
- 80% of prostate cancers respond to medical or surgical androgen
ablation
- Surgical ablation by orchidectomy produces a rapid reduction in
testosterone levels
- Medical ablation is reversible and the effect may take several weeks
- Side effects of androgen ablation include
- Impotence
- Loss of libido
- Osteoporosis
- Gynaecomastia
- Hot flushes
Types and site of hormonal treatment
- Pituitary gland
- LH-RH analogues
- Stilbeostrol
- Prednisolone
- Cyproterone acetate
- Adrenal gland
- Ketoconazole
- Aminoglutethamide
- Prostate
- Flutamide
- Cyproterone acetate
- Testis
Uses of hormonal treatment
- Androgen ablation is used in both the neoadjuvant setting and in
metastatic disease
- In neoadjuvant setting is used in combination with external beam
radiotherapy
- LH-RH analogues are commonly used in metastatic disease
- Median duration of response is about 18 months
- 20% patients achieve response that may last several years
- Response can be measure by a fall in PSA level
- LH-RH analogues are give by monthly injection
- The first injection my induce LH-RH release, a rise in PSA and
worsening of symptoms
- Cyproterone acetate should be give for first 2 weeks of treatment to
reduce this effect
Bibliography
Baum M. Adjuvant endocrine therapy in postmenopausal women with
early breast cancer: where are we now? Eur J Cancer 2005;
41: 1667-1677.
Bickenbach K A. Jaskowiak N. Aromatase inhibitors: An
overview for surgeons. J Am Coll Surg 2006; 203:
376-389.
Koberle D, Thurlimann B. Adjuvant endocrine therapy in
postmenopausal breast cancer patients. Breast 2005; 14:
446-451.
Pritchard K I. Adjuvant endocrine therapies for pre /
perimenopausal women. Breast 2005; 14: 547-554.
Sharifi N, Gulley J L, Dahut W L. Androgen
deprivation therapy for prostate cancer. JAMA 2005;
294: 238-244
Wirk B. The role of ovarian ablation in the management of breast
cancer. Breast J 2005; 11: 416-24 |